Is Race a Factor For Which Children Get Imaging in the ER?

Racial diversity of patients served by children’s hospitals could be related to disparities in diagnostic imaging for kids presenting to emergency departments, researchers found.

Across several dozen U.S. hospitals, Black children were consistently less likely to undergo imaging tests during emergency department visits than their white peers (24.6% vs 34.2%). Hispanic children also had a relatively low rate of imaging (26.1%), according to investigators led by Margaret Samuels-Kalow, MD, MPhil, MSHP, of Massachusetts General Hospital in Boston.

They found that the greater the proportion of Black and Hispanic children among those cared for by that hospital, the bigger a hospital’s gap in imaging between Black and white patients — even after adjusting for possible confounding variables such as sex, age, insurance type, and intensive care unit admission, Samuels-Kalow and colleagues reported in JAMA Network Open.

Ultimately, study findings suggested different treatment of individuals by race within hospitals rather than different patterns of presentation to hospitals, the authors said.

They expressed concern at the increased discrepancy at hospitals that serve more diverse demographics, suggesting that more research must be conducted in order to understand what is driving this trend in the emergency department. One unanswered question is whether the overtesting of one group or undertesting of others may explain the imaging disparities.

Nevertheless, prior studies suggested that non-Hispanic white children typically have more favorable health outcomes when compared to peers of other races. These better outcomes persisted even when the potential risks of overtesting — such as greater exposure to radiation, consequences of false positive diagnosis, and cost to the patient and the payer for the treatment — are taken into consideration, according to Samuels-Kalow’s group.

Samuels-Kalow told MedPage Today that one possibility is that bias leading clinicians to try to meet perceived parental expectations may be to blame for some of the inequity, and that there should be a focus on a more evidence-based approach moving forward.

To address the observed racial inequities, hospitals can start by looking at their own emergency department imaging practices and seeing if there is room for improvement, she and her collaborators suggested.

“We need to understand the hospital factors that are associated with smaller differences in imaging,” Samuels-Kalow said. “What are those hospitals doing well to reduce disparities in imaging utilization? Then we need to take those lessons, and figure out how to implement them at all hospitals, so that we can improve the equity of imaging in pediatric emergency care.”

Their study was conducted using data from 38 children’s hospitals’ emergency departments, focusing on pediatric patients under age 18 who were admitted from January 1, 2016 to December 31, 2019. Imaging procedures included MRIs, ultrasounds, CTs, and radiographs, and were determined from billing records.

The authors cautioned that they lacked key clinical information such as indications for imaging, illness severity, and whether a patient was referred in for imaging. Moreover, the findings may not be generalizable to emergency departments outside children’s hospitals, they said.

Ultimately, Samuels-Kalow and colleagues said more research is needed to understand how guideline implementation and interventions might help close the racial gap in utilization and outcomes of care for children.